Should all advertising of cosmetic surgery be banned? YesBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7489 (Published 07 November 2012) Cite this as: BMJ 2012;345:e7489
Advertising prescription drugs to the public is banned in the United Kingdom, but advertising is allowed to promote invasive surgical procedures that may not be clinically necessary and pose risks of harm and complications. Arguably, the criteria for operating on patients who are not physically ill or deformed should be more stringent than those for curing illness or correcting deformities. A minimum requirement should be a complete ban on encouraging and recruiting people to undergo such treatments—and advertising for cosmetic surgery does just that.
The World Health Organization’s definition of health, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” has been argued about by many, but it emphasises the mental wellbeing of the individual.1 2 3 4 Cosmetic surgery is practised to try to improve this aspect of health: it treats symptoms of self consciousness, a state of mind when a self perceived abnormality of body image affects the wellbeing of the patient.
From talking to the thousands of cosmetic surgery patients whom I have treated in the past 20 years, I know that many live with their feelings for years before they seek help. It is within this context of vulnerability that these patients are assessed and advised about invasive surgery to deal with complaints that are not caused by disease. This has led some to question the morality of cosmetic surgery and to consider it peripheral to medicine.5 Advertising of cosmetic surgery aims to stimulate demand and encourage patients to take risk. This cannot be in the best interests of these vulnerable people. As the ethicists Franklin G Miller and colleagues said, “By promoting dis-ease and thus stimulating demand for cosmetic surgery, such advertisements clearly violate the internal morality of medicine.”5 Such patients must not be taken outside the practice of medicine and the doctor-patient relationship, to be treated instead as clients of a “cosmetic industry,” where a different morality governs the relationship.
Preying on vulnerability
The report of the All Party Parliamentary Group on Body Image found that 60% of adults feel ashamed of the way they look.6 The report refers to many studies, including a survey by Girl Guide UK in 2010 of more than 1200 participants of different ages. In all, 70% of women and 40% of men reported that they have felt pressure from television and magazines to have a perfect body, and between one third and half of all young girls fear becoming fat and engage in dieting or binge eating. Cosmetic surgery advertisements prey on these feelings and vulnerabilities to offer a quick fix.7
“The ads are deliberately designed to convince people who might previously have thought that their appearance was acceptable that they are in fact seriously inadequate unless they seek a surgical correction for their newly discovered ‘problem,’” according to Miller and colleagues.5 A study by the American Society of Plastic Surgeons found that up to 25% of its members violated their code for advertising.8
The all party parliamentary group concluded that a new separate code of advertising for cosmetic surgery is necessary to protect the public, an acknowledgment of the failure of existing guidelines. The British Association of Aesthetic Plastic Surgeons (BAAPS) maintains that an outright ban is in the best interest of patients. However, it has proposed minimum safeguards for patients.9
Adverts that would have fallen foul of the new code include one for the “bikini body transformation package,” which promises a perfect beach body and promises savings of up to £2000 on holidays,10 and a “feel good package,” that targeted newly divorced women and new mothers for breast enhancement, liposuction, teeth whitening, and Botox. We’ve also seen adverts for gift vouchers for cosmetic surgery; cosmetic surgery procedures as lottery prizes; and promotions for half price surgery.11 These advertisements were clearly not designed to inform and help patients. BAAPS has issued many statements condemning these marketing ploys as unethical. Clearly a voluntary code for advertising cosmetic surgery is not enough to stop exploitation that plays on patients’ vulnerability.
To keep the practice of cosmetic surgery ethically sound it is essential to reverse its commoditisation. It should begin with a total ban on advertising because, as Miller and colleagues state, “the consumer-oriented, business context of cosmetic surgery risks compromising professional integrity, particularly insofar as it makes use of demand-stimulating marketing.”5
Physicians have traditionally abstained from advertising for ethical reasons.12 The doctor-patient relationship and the professional duty of care a physician has for patients is not similar to business relationships, where advertising plays an important role in bringing customers and providers together.
France has outlawed advertising for aesthetic surgery as well as defining who can do cosmetic surgery in order to protect patients.13 In the United Kingdom, the Department of Health has ordered a review of cosmetic practices, which is due to be published in April 2013. One remit is to look at the advertising of cosmetic surgery to the public.14 The review should be concerned only with patients’ safety. Advertising for cosmetic surgery may be legal but it is not necessarily ethical. Sir Bruce Keogh, who is leading the inquiry, will be remembered for the action he takes.
Cite this as: BMJ 2012;345:e7489
Competing interests: The author has completed the ICMJE unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; FF is immediate past president of BAAPS. During his presidency the council adopted the list of restrictions quoted in this article for a new code of advertising for cosmetic surgery that was submitted to the Committee of Advertising Practice.
Provenance and peer review: Commissioned; not externally peer reviewed.